Park Se-Jun, Lee Keun-Ho, Lee Chong-Suh, Jung Joon Young, Park Jin Ho, Kim Gab-Lae, Kim Ki-Tack
1Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine.
2Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine; and.
J Neurosurg Spine. 2019 Nov 22;32(3):456-464. doi: 10.3171/2019.8.SPINE19583. Print 2020 Mar 1.
The goal of this study was to evaluate the radiographic and clinical results of instrumentation surgery without fusion for metastases to the spine.
Between 2010 and 2017, patients with spinal tumors who underwent instrumentation without fusion surgery were consecutively evaluated. Preoperative and postoperative clinical data were evaluated. Data were inclusive for last follow-up and just prior to death if the patient died. Instrumentation-related complications included screw migration, screw or rod breakage, cage migration, and screw loosening.
Excluding patients who died within 6 months, a total of 136 patients (140 operations) were recruited. The average follow-up duration was 16.5 months (median 12.4 months). The pain visual analog scale score decreased from 6.4 to 2.5 (p < 0.001) and the Eastern Cooperative Oncology Group scale score improved (p < 0.001). There were only 3 cases (2.1%) of symptomatic instrumentation-related complications that resulted in revisions. There were 6 cases of nonsymptomatic complications. The most common complication was screw migration or pull-out (5 cases). There were 3 cases of screw or rod breakage and 1 case of cage migration. Two-thirds of the cases of instrumentation-related complications occurred after 6 months, with a mean postoperative period of 1 year.
The current study reported successful outcomes with very low complication rates after nonfusion surgery for patients with spinal metastases, even among those who survived for more than 6 months. More than half of the instrumentation-related complications were asymptomatic and did not require revision. The results suggest that nonfusion surgery might be sufficient for a majority of patients with spinal metastases.
本研究的目的是评估脊柱转移瘤非融合内固定手术的影像学和临床结果。
2010年至2017年期间，对接受非融合内固定手术的脊柱肿瘤患者进行连续评估。评估术前和术后临床数据。数据包括最后一次随访时的数据，若患者死亡则为死亡前的数据。内固定相关并发症包括螺钉移位、螺钉或棒材断裂、椎间融合器移位和螺钉松动。
排除6个月内死亡的患者，共纳入136例患者（140次手术）。平均随访时间为16.5个月（中位数12.4个月）。疼痛视觉模拟量表评分从6.4降至2.5（p<0.001），东部肿瘤协作组量表评分改善（p<0.001）。仅有3例（2.1%）有症状的内固定相关并发症导致翻修手术。有6例无症状并发症。最常见的并发症是螺钉移位或拔出（5例）。有3例螺钉或棒材断裂，1例椎间融合器移位。三分之二的内固定相关并发症发生在6个月后，术后平均时间为1年。
本研究报告了脊柱转移瘤患者非融合手术后成功率高且并发症发生率极低，即使是存活超过6个月的患者。超过一半的内固定相关并发症无症状，无需翻修。结果表明，对于大多数脊柱转移瘤患者，非融合手术可能就足够了。
